Here’s a quote that readers will not readily recognize: “It is a pity that a doctor is precluded by his profession from being able sometimes to say what he really thinks.”

I’ll share the origin of the quote at the post’s conclusion. How’s that for a teaser? I’ll give you a hint below.

Physicians, by training and experience, are guarded with our words. To begin, we are never entirely sure of anything, and we should make sure that we do not convey certainty when none exists. This is why physicians rarely use phrases such as, “I’m positive that …,” “I’m 100% sure …,” “There are no side-effects …”

Because of the uncertainties of the medical universe, sometimes we sanitize our own concerns when we advise patients and their families. We may see an individual in the office with unexplained weight loss and a change in her bowel pattern. While we may fear that a malignancy is lurking, we would be wise to keep our own counsel on this impression pending further study. This patient, for example, may be suffering from a curable thyroid disorder.

Words matter. We all have heard how patients and families can dwell on one or two words uttered by a physician, who may have spoken at some length on a patient’s condition. In these cases, the families may have inferred more serious news than the physician intended. Doctors need to be mindful of this phenomenon when we are communicating.

Which of these messages would you prefer to receive on your voicemail?

“Please make an appointment to review your biopsy results.”

or

“Your biopsy results are benign. Please make an appointment so we can discuss them further.”

On other occasions, physicians may opt to leave out certain words or suspicions. Why unload anxiety on folks before the truth is known? Additionally, not every patient wants the whole truth administered in a single dose. These scenarios demonstrate the advantage that a physician has when he has an established rapport and relationship with his patient.

Conversely, I don’t feel we are helping patients and their loved ones when we overly sanitize the medical situation to postpone an unpleasant physician task or to create hope that may not be realistic. There’s a balance to be attempted, and I still struggle to achieve it.

The quote that started this post was published 90 years ago, not by a doctor or a nurse. I stumbled upon it when reading “The Murder of Roger Ackroyd,” one of the greatest works by the master of mystery — Dame Agatha Christie.

Michael Kirsch is a gastroenterologist who blogs at MD Whistleblower.

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